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HomeMy WebLinkAbout004-1061-80-150~f commerce PRIVATE SEWAGE SYSTEM /ision ,~ INSPECTION REPORT JFORMATION (ATTACH TO PERMIT) ,lion you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. s Name: City Village X Township an Cad Townshi ev: Insp. BM Elev: BM Description: CS ~ 3. tom. '7 3 CAPACITY ELEVATION DATA ~( INFORMATION .'PE MANUFACTURER t,~ K-.z.k ~-~' ~~ ~ s idGQ Q, GC, Holding 1 ~~hx. ~ i~- ic~~ TA K SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic 7 I'G~~ ~ T" ,' ~ r ~ ~OG ~. ° Dosing 7 ~(,~~' Nv~- , ,,~ ~' ~ ~' ] ~ y ~CC Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GP ~, M l b I ~ ode Num er ' t~~~t H TDH Lift Friction Loss System Head TDH ,fit ~~.y y . ~ 3. Z 5 ~ ~-~`> Forcemain Length Dia. ~i Dist. to Well tub 4' ~.~c+- ~~ c~ ~ •-- SOIL ABSORPTION SYSTEM county: St. Croix Sanitary Permit No: 453476 0 State Plan ID No: Parcel Tax No: SectionlTown/Range/Map No: 26.28.15. STATION BS HI FS ELEV. Benchm ` ~ " 11. l,O I l •6 ~- ~ t?U -1J Alt. BM ~'io" 5a.c,c~ Bldg. Sewer ~ ~ ~~ -~ ~rZ ~ 4 ~~ 5 . . St/Ht Inlet ~ `t ~ 8~-~-~• / , ~ 'o ~ t'3`-t- ~ ~ ~ ~3 svHt outlgt , ~ ti ~ ' ~ C, ti ,, -31v ~c~ ~7 Dt Inlet ,~, I,, C~ ~~ ~J' Dt Bottom f8 , y ~Z ~, ~ ~ ~ Header/Man. Dist. Pipe ~ ~ ~ `{ ' 'y 'Z• s II~.13 s , Bot. System ~ ~ ~ ~~•S _ / ~ (, Iv3 .? Final Grade r,b3 U ~ \ St Cover ~~ ~'~Z QD ~~ R, 2A o2- k,~r..~~..-~ ~~+ 5.~ goy ~ n-t ~ O . ~ r«=.~ ioc~. v BED/TRENCH Widt t No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS h t ~ ~ I i _._ __ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LE Manufacturer: INFORMATION CHAMBE Type Of System: ,Mow--i~ ~ ~ ~ fCKi NV T 1 e Nl IF° UNIT Model ,. ~~ )t/~. 1 DISTRIBUTION SYSTEM ~%' ilk 5~~ Lt I l •S t ~.' `~ Header/Manifold ~ ~s Length Dia ~ Distribution 5.'~ Pipe(s) ~. / Length Dia I~ Spacing x Hole Size 3 ., ~(Cs x Hole Spacing l Vent to Air Intake ~-- SOIL COVER x Pressure Systems Onlv zx Mound Or At-Grade Svstems Only Depth Over l ' Depth Over ~ xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center i Bed/Trench Ed es (t g ~ To soil p - ~_~ Yes ', No ~, ~ _JI Yes ~ No COMMENTS: Include c ~'r t"``~' ( dls ~p~ricies, p1?rsons presen ,etc. Inspe~on #1:~/• 2 /, Zoa Inspection #2• / 3 / G `'f Location: 142 320th Street Wilson, WI 54027 (NE 1/4 SE 1/4 26 T28N R15W) NA of Q~ei.9 ~~ ,~/!~'t'~ Parcel No: 26.28.15. ~b 1.) Alt BM Description = 70 ~ ~ ~ ~~~~ ~ • "~ c:.,+ G,o ~~-'"~ ~ ~'~ '~~ c' ~ ~ ~ ~~ 2.) Bldg sewer length = CvCt-~ ~ ~ ~-'~' ~ '~ 16~ !`~ ~.-, ~~ /~'_ .\ -amount of cover = ,> y ~ " ~ o ~~`r ~ ~ ~~ ~ ~~ Plan revision Required . Yes ~. No i i~ 3 ~ ~ -7 ~ i Use other side for additional informati 1l ~ ~ y 1, i ~~~° ------ - ,I - - --i`- L--- -~ Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) Safety and Buildings Division County ` 201 W. Washington Ave., P.O. Box 7162 ~ ~ Q..fl/ X ~~~0~~~~ Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) (608) 266-3151 53 ~~ Department of Commerce Sanitary Permit Application State Plan I.D. Number Wis. Adm. Code, personal information you provide In accord with Comm 83.21 D O TQ~s • ~D , may be used for secondary purposes Privacy Law, s15.04(1)(m) Project Address (if different thtut mailing address) ~ 1 `EZ 3ZO 5+. L Application Information -Please Print All Information ~'-` ~~ CS , . ~ ~ t ~.. ~^,_"'"`""I ~ ~~ I . 5. ~A 9.., t a^ ~ i . V Property Owner's Namc w ! P ccl # of # > Block ~~ S // r ~ ~ i d.,, h V~ r;~,; Property Owner's Mailing Address 1 I 3 ~_ , ,,~:~ ~~~~ ~- 2 Zo ~ ti 5 ~ pcrty Location w ~~ ~ Section 'Z '/. '/. City, State Zip Codc 0 b e -- , , ~lJ V 1/LJQ- T !~ N; R /`7 l~ot~ e of Building (check all that apply) Il T orA . yp z I or 2 Family Dwelling - Number of Bedrooms ,J Subdivision Name CSM Nu ~c~ (o~j~ e S ~'Y( '7J_ ~ s~~..~ r, ^ Public/Commercial -Describe Use - ^ State Owned -Describe Use ^City_^Villagc~Township of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A' ~ Ncw System ^ Replacement System ^ Trcatment/Holdin Tank Rc lacemcnt Onl g p y ^ Other Modification to Existin S rem g Ys B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to Ncw List Previous Permit Number and Date Issued Before Expiration Plumber Owner I / IV. T e of POWTS S stem: Check all that a I ~2 ~ _ .~ ^ Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ~ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Pcat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipc ^ Other explain) ~ V. Dis ersaVTreatment Area Information: Design Flow (gpd) Design Soil Application Ratc(gpdsf) ~ Dis crsal Arca Required (sf) ~ ~ ispcrsal Arca Proposed (sf) System Elevation " y~~ ..~ C~° s ae~.g3r s ~ ZZg3.~5 ~~~5 / VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units 4~(~~ _/~ Concrete Constructed Glass N w Existin I e g n r _ ~'j~ Tanks Tanks "H Septic or Holding Tank Q~V GU i , /~~/_ V'~ IL > Aerobic Treatment Unit Dosing Chamber ~ /~,r}.~ ~ /~ VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plu er's Namc (Print) Plumb 's Signatur MP/_MPRS Number Business Phone Number ~ 'Z2(oSZ~ ~/ - 7~L -~~ Plumbe 's ddress (Street, City, State, Zip Code) ~/ ~ 9v"~ c,1r~ 27 VIII. Coun /De artment Use Onl ~Approvcd ^ Disapproved Sanitary Pemtit Fcc ( S h F includes Groundwater Datc lssucd Issuing gent Signature (No mps) ^ Owner Given Reason for Denial arge urc cc) [X. Conditions of ApprovaVReasons for Disapproval SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. " Attach complete plain (to the County only) for the system on paper not Tess tnan »trt x t t mcnes m size ~~ ~~~ SBD-6398 (R. 01/03) -i 1 ~ y ~ fl,~ i „ y~ y~ G.,,~ d,y` ~ ~ -~ p~ q Q_S O ~. ~r a~w~ VC 0 0- CYl- Q ! „'" 4 .1 Cn~Q.~~ ~ ~*c7 S ~~.~ :~..E a ~v a..ei~ gab .. ~~ 4•~ S v.w ..` 3 t... S! Z r ~ 2' ~L ~ ~ o' y." ..r.>.r~ 1.1~~~..o~ art ~` ~ ~ t.Y r ~ `e`.lc `~`` ~~ ~~ h OQ~ G ~~ 1.... K ~ o s .~-f IV ~ J .L d 2 a ~v Lt ~ ... C~ ~ a .~ »~ ~:1~ x,01 e ~ s ~~. ~.t.~... ~„ "~'~..`.., ~~'ti ..~ ti <-.r..a 't.tz-i~'.n C~•r,~oti. r w, ~acct~[,' d r~ 7~ ~~~ a~ ~~{, `1 / ~~1 `L~ { ~ S~. R~,~ ~ --~ tii C1.~~,`a~ CIF-Sw-Z6.Zg-IS ~ \a.~ ~~~: C~~ 3~-q-' 2" C'vc q,Sl~ q-b 1j-W.c-.~ K. L~ N ~.'~!'1~ ~ o ~ ~ commerce.wi.gov isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. commerce. state.wi. us/sb www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary June 10, 2004 CUST ID No. 226524 ROGER L TIMM TIMM EXCAVATING 3128 20TH AVE WILSON WI 54027 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/10/2006 Identification Numbers Transaction ID No. 1006134 SITE: Dan Wold Site ID No. 684620 Town of Cady, St Croix County Please refer to both identification numbers, NE 1/4, SW 1/4, 526, T28N, R15W above, in all corres ondence with the a enc . Lot: 1, FOR: Object Type: POWTS Component Manual Regulated Object ID No.: 962130 Maintenance required; 450 GPD Flow rate System(s): Mound Component Manual -Version 2.0, SBD-10691-P (N.O1/O1), Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.O1/O1) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the septic tank outlet filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. • This system is to be constructed and located in accordance with the approved plans, and the "Mound Component Manual for Private Onsite Wastewater Systems Version 2.0" SBD-10691-P(N.O1/O1). • The pressure network is to be constructed in accordance with publications SBD-10706-P(NO1/O1) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems -Version 2.0" and/or the sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/instal lation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. ROGER L TIMM Page 2 6/10/04 Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sinc rely, ' ~i / .-L . ti Leroy G. Ja lcy, Waste er Speci st Integrated Services Bureau (715)726-2544 lj ansky@commerce. state. wi. us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMAEZT code: 7633 cc: Leroy G Janslcy, Wastewater. Specialist, (715) 726-2544 Henry F Grote ,Certified Soil Testing ating .: ®®~ ~~"~ Dan Wold -Mound RE~E~~Fp JUN - ~ 2004 SgFE~, & B LDGS p1V. Construction Materials and Techniques All materials must comply with Comm 84 and be installed in accordance with manufacturer's specifications. Construction methods must comply with the following Component Manuals: Mound, SBD-10691-P (O1/O1) Pressure Distribution, SBD-10706-P (Ol/O1) Location: Lot 1', NE'/4, SW'/4, Sec. 26, T 28 N, R 15 W Town: Cady County: St. Croix Date: June 10, 2004 Owner: Dan Wold Address: N 7443 540`h St. Menomonie, WI 54751 Plumber: Roger Timm Signature: License: MPRS 226524 P o.w.-r.s. Conditionally A~P~OVED DEPARTMENT OF COMMERCE DtVtS~ON OF SAFETY AND BUILDINGS SEE CC6~RESPC~dDENC Attachments: SBD-10577 -Plan Approval Application SBD-8330 Page 1: cover 2: design criteria & calculations 3: plot plan 4: system cross section 5: plan view, lateral detail 6: pump tank exit detail 7: pump curve 8: system management page 1 of 8 ~~ Design Criteria ~~`S Residential Wastewater Contaminant Load: 30 mg/L < BODS < 220 mg/L Anticipated septic tank effluent 30 mg/L < TSS < 150mg/L Fecal Coliform > 10,000 cfu/100 mL Fats, oils, grease < 30 mg/L ~ Bedrooms x 100 gal/bedroom/day x 1.5 ~ ~ gallons/day hydraulic load In situ designed loading rate Depth to estimated high ground water Depth to bedrock Cross slope at system Force main length Manifold/header length Drain-back ~ ~ •~ t~ Lateral length ~ @ S S'. S' Lateral elevation ~'O`~- Lateral hole size ~~~ ~ in. @ ~ ~ ~ I `~ holes/lateral 3 g Lateral volume ~ ~ ,z~ z Total lateral discharge rate 2 ~ • ~ ~ Network pressure compensation losses `~ '~ s~ Elevation difference ~~~` ~ ~- Friction loss ~ :S ~ ~ ~ Total dynamic head ~ Z. ~ S~ Pump/si ~ gpm @ 3 s~ Manufacturer ~~ ~- ok.~ ~.-~ 3 ~ g~ Dose volume ~ l 9 , ~ '~- Lift/si~hon tank ~ ~-~- ~ Septic tank ~ ~e~l~ Effluent filter ~ ~- ~ - ~ ~ Measurement pump on and off ~' S~ Height alarm from tank bottom ~ b Reserve capacity a-~{rS ~' specs.caics.res Design Calculations °, Z. gallons/sq. ft. per day ~ z in. ~ Z 8 in. ~ ~;~ ft. of Z in. ly ~ ft. of - in. gallons ft. of ~~ ~ ~ in. ft. @ bottom of lateral in. ( 3 ~ ~ ft.) Spacing holes total gallons gallons/minute @ Z' ~ ft. head ft. ft. ft. @ ~'' gallons/minute ft. ft. of head Model # t^'t ~ 5 I-I gallons ~ ~ gallons t ~^'~ gallons in. m. gallons Page ~ of g fit` owe ((~~~ a~~~ , ~.~./~. ~.. 5~(~, <~n~s~ 3l 2~~ o L 4 sti 1~ u ~..,,. 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'~ IV ~ J 3~t 2" Pvc s.SL~ «-u ]"~i ~ c"Q_ Nr Fes, h ~t t ~ i; ~~ ~ ~ O Z .n ~-v LV o rd ~ S a1- `nett. .`~~' +-. ` ~- h. ~ aY ~~ ~l ~zo~`` S~. ~/w ', ~` ~, ~'~ ,~ ~ `~ Y, \~{r 1 r -~ /L / ~~ ~~,5~ ~ O~ 11 ~1 tt ((~~ '~~-'~,'Z we-s~taQ I ~wX 3 .. r. .~~ `., b.,1o,., ., r:; 1 ~ t9.~3' aa.a \ 4~oovt ~..~tw~ c.~..av..~ `"~ c o ~, s / ~ t~,tir.y \ c a m 1 Z•O~ ~,3Z' ~-1I ~ w-•SL ` ~ b i~~co:1 lar.A o.v ~.` ....lot . ~~ ~-" ~ ~ 2~ .. 1~ , ~`~Z e-a~c~.~a~e,~, t U 1~~1 l •_._~~ O ~ __.~._~ __ • -. 1. `a~n V :two, ., --~_ ~~, ~34~ ~ J I13.S~ ~ ~ '. ~ 1~ V L e..~.~ y~ t ~ o~j S ate. v .~ ~-: o ~. w 21 \ i ~ ~O~ o ..-. o } Y o ~l~ V .~ ~ ~'. 1 vi- a.~...~ L ~ n~v- .,..:....~. ~- a C~ ~~ S ~, ~ o .,.,. ~ ~ (\~~ ~ C 1 Il Q ~--~ ... r r v~ `ti }XM~ [U l (~ ( ~KrN ~ K~ c..~, ~o+ ~,.~ ~ ~ro 1. ~t Q.v .JL ~ er~ 0..: \ ~ ~..~~. ~.,, o.~.d o ~ s~ ~. 2„ ,, Puy s.S. 40 ~o~« ~-..~: ,~ 1` " ~ Z P~ ~ s ~~ 4v .~. ~...Q -~ ~ / ;,.o~ i I ~,o' I I,S ~~ t.5' I ~.o' 3, 0' I Z„~, _, ` \1~„~~ ~ /~ I' K o\ a~ o ~. \ ~. 't QJ~. ~ CSty. ~~ O r.. ` ~ »Q.. ~ ~ b ~ ~ ( ~ , O ~ J 4 a.r. ( c ` ~~ 1Ve~2-a, ~~v~i~as.F ~~.~r ~. (~".~ ~ra1~e ~oh ~~ s .c ~-~ ¢ o , 2 9,~ ' ~- Ib, 3' ~~~ ~.~;h ~, VEtJT CAP '1~ C.I. vE,~1T PIPE WEATHER PROOF APPROVED LOCKIAIG > JUAlCTIOAJ BOX MANHOLE COVEF. - 2 ~ =ROM DOOR, `Z1 ~/ w ARN~a WIIJCOW OR FRESH I LAQ~L AIR IIJTAKE GRADE ~ a.\ea,, ~~ b ~ 4,~ CO-JDUIT ~-- I~ ( f L.. x ' -1~ ~ ~l, o .,..,~ ~ o~~.. w-~~c~ \~ v ;.,~~~ ---~ ~ -~ ~~ _ ~~~;~ \'I \11~ PROVIDE ( ___ __ AIRTIGHT SEAL ` ' ~ ~ ` ~ i ( ~ T ( ~~~ ~ ~~iL7Rv LS 7.0,E / I I I ~ I ~ I I APPROVED JOIUTS W/ PIPE VI/ ~ ~ I ALARM EXTEAIDIUG 3' ~~~ I _. - I i ~ ONTO SOLID SOIL ,~ ~,. ~ ~~ ~ I I o~, ~ to, S " I ~ PUMP-~ __J 11 ~ 9, ~' ¢.\a,u r OFF . ~~~ DLOGK ~~-~ S3 0 " /, o l ~J z~, ~~.~ ~ ~ ~ a ~~ `'~` ~..~~o~~ ,. .' ,~ For Homes Farms s Trailer courts Motels ~' Schools Hospitals Industry { Effluent Systems anywhere effluent or drainage must be disposed of quickly, quietly and efficiently. Heary-Duty Dependable Solids Handling Capability to 3/4" ,C 'h, '/z H.P. 60 Hz Single Phase 115, 230 Volt. 'h, 3/4, 1, 1Y2 H.P. 60 Hz Single Phase 230 Volt. Three Phase 208-230, 460 Volt. i 90 80 F- 70 w w ~` 60 O Q = SO U Q 40 z 0 30 J H O 20 F- ~o 0 Bulletin CL2.1A July 8, 1983 R:~ ~~~~~ Model 3885 (Supersedes Model 3870) Submersible Effluent Pumps _. ~- ,- - - Sclids Handllnq Ca~_,!' • .: _,. _,.., s:-- _ ~~_- Semi•Cpen 1mpeRer Cas~nc Stainiess Steel Fasteners res!sroce Mechanical Seal r ., ~r - _ .. . - Maximum Temperature 160°F. Capable of Running Dry ~Nithou! d2mage ;e component. Motor Specifications Motor Fully Submerged Bearings Stainless Steel Shari ~en_, _~_ _~.~~-.less -- ''~` ~- ~-- Single Phase Unrts Three Pn;:,: Vr..., Povrer Corc Single Phase Uniis SJTO .v~:~~ :;~Grcnc o _.. ..~ _ - - SPECIFICATIONS ARE SUBJECT TO CHANGc WITHOUT NOTICE '0 ~GOULDS PUMPS, INC. 'f o GALLONS PER MINUTE • System Management Management of this system is critical. As a condition of approval of these plans this system management section must be reviewed with the owner, and the owner must be provided with a complete set of plans including this management section. If problems develop with the adsorption system or any other system components, the installing plumber, Timm Excavating, 715-772- 3214, or the St. Croix County Zoning Office, 715-386-4680, should be contacted for assistance. General Proper functioning of an on-site disposal system, "septic system," is significantly dependent on the volume of water which flows into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the better and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a dose tank or compartment to allow a dose to be accumulated, a pump and controls or automatic siphon, and finally some type of soil adsorption cell to recycle the water in a manner to protect ground water quality and public health. 1. If the septic tank is installed prior to sheet-rock andlor painting, pump the septic tank before normal use begins to ensure adherence to contaminant load design criteria. 2. Install water-saving appliances whenever and wherever possible. 3. Repair even small water leaks as soon as possible. 4. Never pour grease or oil down any drain or stool. 5. Garbage disposals are not recommended; if you must have one, use it sparingly 6. No paper products other than tissue should go into the system. 7. No chemicals should go into the system. 8. Avoid surge flows of water; try to spread laundry throughout the week. 9. Septic tank effluent must be less than or equal to the design criteria specified in page 2 of these plans. 10. If septic or dose tanks are no longer used, they must be properly abandoned. 11. If construction timing and weather could create a frozen infiltration system, weather-proofing with plastic sheeting and heavy mulching may be required to maintain a functional system at start-up. 12. if possible, the upslope toe of the mound system should be landscaped with additional fill to blend this area into the upslope natural grade; this will minimize the possibility of the system trapping surface run-off; final settled slope should be 2-3% over the system or 2-3% diverting surface run-off around the ends of the system. Maintenance I . The septic tank must be inspected every three years by a properly licensed person. 2. if necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids volume equals one third of the tank volume. 3. When the septic tank is pumped, any solids in the bottom of the dose tank must be pumped, and the filter must be back-washed into the septic tank to remove accumulated material. System use may require more frequent filter cleaning; initial inspections of the filter should be made every 6 months until a minimum time sequence is determined. 4. Periodic observation pipe inspections should be made by the owner to examine the state of the in-situ soil adsorption cell. Quarterly inspections are recommended; a licensed plumber should be notified if effluent is consistently ponded in the adsorption cell. 5. If this system contains specific treatment components other than those mentioned here, maintenance requirements will accompany their specifications. 6. The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump. If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows reserve capacity to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or two days should pass before any necessary repairs can be made. 7. Avoid compaction such as vehicle traffic within 15' down-slope of the adsorption system. 8. Avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system. 9. Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth. 10. Surface drainage must be diverted around the system; avoid landscape changes which might send surface run-off into the system area. 1 1. Warning: Do not enter septic, dose or other treatment tanks; death may result because they may contain lethal gases or insufficient oxygen. Contingency Plan Wastewater monitoring of volume and quality is not a normal requirement for low effluent strength systems; such monitoring may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.54 (2). Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing, and/or installation of additional treatment components or conversion to a holding tank may be necessary. Page 8 of 8 ,Q r~ w (~ Wisconsin Department of Commerce SOIL EVALUATION REPORTi\ Page ~ of Division of Safety and Buildings in aCCOrdanCe Wlth c:omm tl5, WIS. Agm. was Cou st Pl an mu Attach complete site plan on paper not less than S 1/2 x 11 inches in size. i d ,I , on an but not limited to: vertical and horizontal reference point (BM), direct include p I.D. y , scale or dimensions, north snow, and location and distance to nearest road. percent slope ~ , Please print all information. Reviewed b ~ Date l Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ? C'/j ~Q Property Owner ~ Property Location (; OFO~N Lot /l)L~' 1/4 S ~'I/4 ~yd ~ N R l'~ E (or) W vt G ~ i.V ~. . o Property Owner's Mailing Address Lot # Block # Subd. Name or CS City State Zip Code Phone Number ^ City ^ Yllage .own Nearest Road [~ew Construction Use: ®'Residential / Number of bedrooms ~_ Code derived design flow rate 'y-S~ GPD ^ Replacement ^ Public or commeraal -Describe: Parent material ~~ ,mod. '~,1~ _ Flood Plain elevation if applicable ft ~ General comments ~~l~cl~ C~ and recommendations: ~5 ~ ~ ~ k ~ 5 ~ ~'~ ~/ - oPu o ~ C 2 ~~ .a ~.- c ~ C-~ ~ ~ L -PV ®~ ~-w~ LL6~t % fe'~ ~-c.c 1 O , ~ 1 / . `© ~. ~ ~~- ~ Gt ~ ~ rn 7CT) [~ t/ ~Ln /. ~ ~ _ ~G , S 7C~ ~Lrel~ U Boring r Boring # ~ ~ in. I ~ Pit Ground surtace elev. ~ ft. Depth to limiting factor ._~_ Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Etf#2 -~6 ~ ~ ~ a ~`~' S .~p 40 ~ Boring Boring # I "~ I qq~~ c~ C- Pit Ground surtace elev. __L_.L~ ft• Depth to limiting factor ~a in. SOLI Iication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff< in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 7 tti, a~ ~ C b GLC~ ~ ~ ~F ~ ~ ® ._ o .. ~ _ n ie/ 9 ' Effluent #1 = BOD > 30 _< 220 mglL and TSS >30 _< 150 mglL 'Effluent #2 = BOD _< 30 mgA. and T~ _< 'su rrrgcr. CST Name (Ple rant) Signature CST Number Address ~ Date Eva uation nducted Telephone Number F ~} Property Owner ~~''` ~- ~) f ~ ~ +~ Parcel ID # Page ~ of ~~ ~~ Lf Boring Boring # ~ ~ ft, Depth to limiting factor ~_ in. Soil lication Rate Pit Ground surface elev. ®~ tion ri D R d Texture Structure Consistence Boundary Roots GP D/fF Horizon Depth in. Dominant Color MunseN p ox esc e Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 3 l ~ ~ l~ ~ ~~ ~---~ ~ c ~ ~ .~ .~ Boring # U~ Boring L'~ Plt Ground surface elev. ~~~• ft. Depth to limiting factor _,/~ in. Soil ication Rate ti i D Texture Structure Consistence Boundary Roots GPD/ft° Horizon ~~ Depth in. Dominant Color Munsell ~ p on escr Redox Qu. Sz. Cont. Color `^ /~ l Gr. Sz. Sh. -~ ~ ) ~ Lv~ 'Eff#1 O ~ 'Eff/]#~/2~ L Ei . ~ ~ `~-, O ~a D ~ r h a- ~ c..tJ ~ ~ F (o i ~ 7 0 2 ~- L "" ~ ~, U Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ^ Pit Soil lication Rate t e T Structure Consistence Boundary Roots GP D/ff< Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color ur ex Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #1 = BODS > 30 < 220 mglL and TSS >30 < 150 mgft_ 'Effluent #2 =BODE <_ 30 mgft. and TSS <_ 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8730 (R.6/00) ., ~ - - /~-- F. ~ ~. a ,,, ( ! ~ +~ o ~ /'©~ t r 7 ~ ~ j ~1 ~ ~' ~ w (V - - • i FJ ~ Q G ( ~ !n) ~ ~~ y / /I o (g S S ; °` ~ w ~ ~ ~ iT ~ ~ 1"t ~ o ~ L. ~ ~ ~ ~ ~- ~ ~ o ,o ~ ~ ~ o ~ ° " ~~ j i ~ p (d ~ , p ~ (~ ` ~ ~. rJ ~ ~6 ~ ~ 0 ~ ~, ~ ~ ~ ~ ~. ~ ~: ~. t ~ h O Q ~3 ~ A Y /y ~^ 1J z 2, ~« ~ --~ .~--r-t--- a -- + /a~ n~ ~~`~ .L i a ..c -- `- -- J' _-- ~ -- J--- --r te ~~ v r "'~" °'~ A" .s W a LV ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer r~~~ wit (.~ O ~c•I Mailing Address ~'l/` 7 yy 3 ~ yU ~~' ~~ j?22yLayr~ryue.., ceJ~ Property Address ~~ (Verification required from Planning Department for new City/State f i 1 V I ~,~ 1~ ~. Parcel Identification Number ~ - ~~~ ~ ~ LEGAL DESCRIPTION Property Location ~~~ '/<, ~ '/<, Sec. ?h . T~N-R_LS W, Town of Subdivision Certified Survey Map # _ . Lot # ~_. tg ~ 6~ Volume ~ .Page # Warranty Deed # ~~ ~ ~ ~ ~ Volume ~6 Page # Spec house ^ yes ~ no Lot lines identifiable ~ yes ^ no SYSTEM M[AINT'ENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeymanplumber, resttictedplumber or a licensedpumperverifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwt, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating your se 'c system has been twined must be completed and returned to the St. Croix County Zoning Office within 30 days thre e n date /~~/~~ SI ATURE O APPLICANT DATE OWNER CERTIFICATION I (we) rtify that aII statements on this form are true to the best of my (our) knowledge. I (we) am .(are) the owner(s) of th pr erty s 'kf a ove a of a warranty deed recorded in Register of Deeds Office. y (/ ~/ ~//~7' SIGNA OF APPLICANT DATE ****** Any information that is mis-represented may result in the sanitary pernut being revoked by the Zoning Department. ****** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed U _.263~i P S~II DOCUMENT NO. WARRANTY DEED This Deed, made between Duane F. Wilman, a single person, Grantor, and Daniel D. Wold and Tracey A. Wold, husband and wife, as survivorship marital property, Grantee, WITNESSETH, That the said Grantor, for a valuable consideration conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin: 7 '7 3. 1 '7'' 4 iILATHLfifiH H. YA1.SH ~ ISTfiRxO~Dfi6tDi BfiCfiIVED FOR RfiCpgD 89~89~20fs4 el:3ilPx MARRAHTY DiEfiD Exdas s REC FBEs 11.88 COPYSPEE~ 145.58 CC FEEL PAGESs 1 RETURN TO: Loberg Law Oftice 359 West Main St. Ellsworth, Wl 54Q~ 1 _ Tax Parcel No 004-1061-80-000 A part of the Northeast Quarter of the Southeast Quarter (NE%dSE'/,) of Section Twenty Six (26), Township Twenty Eig (2~ange Fifteen (15) West, Town of Cady. St. Croix County. Wisconsin, described as follow Lo h i.rer#ified S ~r~Ryc-Mai fiJsd ~~~^P ?O~d in yol 48 of C M-na 4764, as Duo. 7~ arce ormerly known as Lot One (1) of Certified Survey Map filed in Vof. 1~ DOT Approval No. 55-29-3687-2003 This is not homestead property. Together with a0 and singular the hereditaments and appurtenances thereunto belonging; And Grantors warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except and wiil warrant and defend the same. Dated this 2~ day of .lulu , 2004. (SEAL) ~.._/ AL) Duane F. Wilman (SEAL) AUTHENTICATION Signature(s) authenticated this -day of , 20 TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Stats.) TH15 INSTRUMENT WA5 DRAFTED BY LOBERG LAW QFFICE Robert L. Lobera (Signatures may be authenticated or acknowledged. Both are not necessary) tm/dv ACKNOWLEDGMENT (SEAL) STATE OF WISCONSIN } } ss. COUNTY OF Il } Personalty came before me this Z ',_ day of Jufv , 20 04. the above named Duane F. Wilman to me known be the persons who executed the regoi i ent n ,acknowledge the sa -'~---~~ w L Notary Public ~ County, Wis. My Commission is erma I ot, state p ~~'1a~Y _,) expiration date: , 20 CANDICE L. BALD}NI Notary Public State of Wisconsin FORM NO. 985-A Stock No. 26273 VOL ~ 7 PAGE 4520 KATHLEEi1 H. M~Z~--- REGISTER OF DEEDS CER TIDIED SURVEY MAP 05019/2003 R02E40PIt VOL UME 77 PA GE 4520 RECTFEEED 13R00Y xAP COPY FEE: PAGES: 2 L OCA TED I N THE NE 1 /4 OF THE SE 1 /4 OF SECTION 26, T28N, R 15W, TOWN OF CA D Y, _N_ ST. CROIX COUNTY, WISCONSIN. PREPARED FOR: Duane Wi 1 man . ,t.13. PREPAREO B Y.• Lee Vi 11 en e u ve, R . L . S . ,;~;,~~~'; G ~ "x~:+. NORTH I S REFERENCED TO ~ ~~/" r~, '~'.;~ THE EAST LINE OF THE SE1 /4 S' l OF SECTI 26, T28N, R15W. l~'E c• ~, ~ VlL1 E^!E{t~~E ' ASSUMED T BEAR SOO "32 ' 35 "W. d ~ ~ f ,,} =. .^.~ W ~ M~„c:,s I ;=i w ,~, WISCONSIN D. O. T PROVAL - ..a ~' ~'° NUMBER 55-29-3687- 003 ...- ' ~~', a <: -:.:, _~,,, . Unpletted land 1" OIAMETER SURVEY MARK w/ ~~ _ _ NAIL FOUND AT EAST f/4 ORNER r OF SECTION 26 T28N 5 \ CORNER OF SECTION 26-28-15, E / w 1/4 LINE-26-TOTAL 5 7.03'x/ ~ + 4246. 04 ' S89 O ' 35 "E 990.9 ' 89'20'35" 957.99' - - -"-' ~J 33. 00_' . 6 + I .stq • ~ I I ~ ~ 435, 600 SF/ 1 . 00 ACRES w/ OAD R/W. f ~ + a a, R, ~ - T 1 - ~~ 1 ~ ~ W al I~ jl ~ 421, 095 SF/ 9, 67 CRE w/o ROAD R/W. ~ ~ (~ Q~ ~I ~ v O + + + ~ ~ J ~ I + 75O 79' 33. 00' ~ ~+ ~ ~ I ~ ' " NB9 20 '35 'W 792. 79 ' I v ~ "+ NB9 20 35 W - - W ~ -C '~ •• + 198. 20 ' = + ~I ~'P z '~ ' 348, 4 O SF/ 8. DO ACR S w/ ROAD R/W. I nl , ~ I ~ ~ I ~ ~ ~ L o T ~ + ~ ~I y W ~ ~ ~ - -_ ~ I O ~ 3 3, 975 SF/ 7. 67 ACRES w/O ROAD R/W. o a + ~ Q + ~ ~ . 9s U I c~ Q I 759. 79 ' 33. 00=-- 4 N89 °20 ' 35 " W 792 9 ' e ~ I o I LEG . S D ~n~atte~a 1c ~ ti m I J+ I O = 3/4" x 24" IR _ _ REROD SET. ~ ~, J + ~o MIN. WT. _ .502 LBS. / L.F. 1 " DIAMETER SURVEY MARKS w ~ ° -~ PUBLIC LAND URVEY CORNER AS NO NAIL FOUND AT SE CORNER O SECTION 26-2B-f5. o TED. ~ s SOIL TEST HO LE. GRAPHIC SCALE 1 "=200 ' APPROVED ST. CROIX COUNTY PlanNnp Zoning and P~Frt~a Committee O 200 400 600 MAY 1 $ 2003 Page 1 o t 2 shee i s . If not recoroed within 30 days of approval date approval shall be null ttroi void VOI. 7 7 Page 4520 • ~ FORM N~O. 985-A ` !'it~lViiller o.... ~..~.......... Stock No. 2b273 G~i~?T/~l~T~..~1' J1~?1/~Y M~ YoLUrTE _? s __ P~4c5E _~ 7 4 LOGA7ED /N THE 1VF//4 OF 77NE 5El/4 OF SFGr/oN 26, 7~BN, R/5i~1~ TOWN OF GADY, ST. GRO/X GOIVNT ; W/f~GINS/N. P»larging and auperaed/r-g Lot / of Gert /ed 5rirvey Yo/ume TT7 Page 4520 _N_ PREPARED FOR, DucxFe W/Iman. PREPARED BY: Les vl//enauvs, R.L.S. xoRTrl l REPEREr/GED ro THEE T L//YE OF Tf~E ~//4 OF SEGT/ON ~6, TZBI~ R/5NL TO ° : Tho pvrpoae oP thM survveeyy mop /a to , snlmge Lot l oP Gert/P/ed 5w-vey Mc~ < volumo 77, Page 450. to accomodate the area nesc~a oP the Putura owner. ti's ~ro~C. C7 ~S ~' w-...~,i, 4, LEE F. "' ~ VI SENEUYE ~ ~7 MEPI ~ ~ E. ~ ~~~ N~i~~ ~~ '~/0 7 7 6 4 5 0 7 VOL 78 PAGE 4764 16bJ 0L/ "LIONS! NA : 4,AD CfiRTIFIfiD SURVfiY 1lAP RSC FEfi : 13.00 COPY Ffifi: 3.00 PAGfiS : 2 the~~ Gro/x c~o~rr~.yr orrice %F4- FO/.PIG AT TFdE H6trST //4 /" DI.M~TER 5UQVEY MARKER w/ C7P` 5EGT/G~1V Z6 3D-/3, NA/L FGYJNO AT E.49T //4 GOR1~fiQ OF 5EGT/GN~f ~6, T,?B/~ R/SW u-L~/acted /and C /W //4 L/rF26-TOTAL + 3?9ZGlj' ~ ,~ zoo w ~. ~ - t` 575297 5F/ /.s AD R/Nf. ~~ Matted Land ~ ~ LOT 3 ~ ..wt /sr-nrLV or wJJ~ ~ 560,73/ 5F/ / 5 ~'r/o ROAD R/NL ,.ro .ranray P.,~aowc~.~ slb.sr ~r.rs, "s.O~ NB~I ~O~a'%N I~O~I.O6' lh~tted land i _Lot 2, G5M ~/o/ume /7, PocZe 45201 LP6PND_ O = 9/4" x ?4" /RON REROD SET. /• DIAML`TER SilRVE1 M/N. HiT. _ /303 LEt4 / L.P. /JA/L /'OY,PID AT SE G -~-= PL~L.IG LAND 5/AQVEY GORJ~7Q A5 NOTED. SECTION Z6-~O-/5. ~~ ~ ` ~I •~ ~ i~ ~ I ~~ ~ ~ ~~ ~~ ~~ ~ gl ~I ti ~~ GRAPHIC SCALE 1"=300' O 300 600 900 Pages / oP Z sheets. ~3 3 Vo1.18 Page 4764